Browse our Medical Journals - AKJournals
Among all scientific traditions alive, medical publishing has a good chance to be the oldest. The first fully peer reviewed academic journal, “Medical Essays and Observations” was launched in 1731 by the Royal Society in Edinburgh. Since then, hundreds of medical journals have been published worldwide. Medical publication in Hungary started in 1857 when the famous physician, Markusovszky founded “Orvosi Hetilap”, which has been published since then every week (with short breaks during the world wars). It is now a most prestigious piece in AKJournals’ portfolio, listed in Journal Citation Reports, with a remarkable impact factor.
Medical and Health Sciences
Abstract
The abscopal effect, a rare phenomenon in cancer treatment, involves tumor regression in a distant location from the targeted therapy. This case focuses on a 74-year-old woman with metastatic papillary thyroid cancer. Despite prior treatments, she experienced pulmonary nodule progression and hemoptysis. Bland particle embolization was performed on the right bronchial artery branches supplying lung metastases, leading to significant reductions in size, number, and metabolic activity of the right-sided nodules and decreased metabolic activity of the untreated left-sided nodules, without additional cancer-related treatments. The abscopal effect has been observed with various interventional oncologic procedures, indicating a potential role in stimulating the immune response and altering the tumor microenvironment. Further investigation is needed to understand bland embolization's immunomodulatory effects and implications for triggering the abscopal effect.
Abstract
Background and aims
Impaired inhibitory control accompanied by enhanced craving is hallmark of addiction. This study investigated the effects of transcranial direct current stimulation (tDCS) on response inhibition and craving in Internet gaming disorder (IGD). We examined the brain changes after tDCS and their correlation with clinical variables.
Methods
Twenty-four males with IGD were allocated randomly to an active or sham tDCS group, and data from 22 participants were included for analysis. Participants self-administered bilateral tDCS over the dorsolateral prefrontal cortex (DLPFC) for 10 sessions. Stop-signal tasks were conducted to measure response inhibition and participants were asked about their cravings for Internet gaming at baseline and post-tDCS. Functional magnetic resonance imaging data were collected at pre- and post-tDCS, and group differences in resting-state functional connectivity (rsFC) changes from the bilateral DLPFC and nucleus accumbens were examined. We explored the relationship between changes in the rsFC and behavioral variables in the active tDCS group.
Results
A significant group-by-time interaction was observed in response inhibition. After tDCS, only the active group showed a decrease in the stop-signal reaction time (SSRT). Although craving decreased, there were no significant group-by-time interactions or group main effects. The anterior cingulate cortex (ACC) showed group differences in post- versus pre-tDCS rsFC from the right DLPFC. The rsFC between the ACC and left middle frontal gyrus was negatively correlated with the SSRT.
Discussion and conclusion
Our study provides preliminary evidence that bilateral tDCS over the DLPFC improves inhibitory control and could serve as a therapeutic approach for IGD.
Abstract
Background and aims
Since the inclusion of Compulsive Sexual Behavior Disorder (CSBD) in the International Classification of Diseases (11th ed.), there has been little effort placed into developing clinical recommendations for lesbian, gay, bisexual, and queer (LGBQ) clients with this condition. Thus, we develop preliminary clinical recommendations for mental health professionals working with LGBQ clients who may be struggling with CSBD.
Methods
The present paper synthesizes the CSBD literature with advances in LGBQ-affirming care to develop assessment and treatment recommendations. These recommendations are discussed within the context of minority stress theory, which provides an empirically supported explanation for how anti-LGBQ stigma may contribute to the development of mental health conditions in LGBQ populations.
Results
Assessment recommendations are designed to assist mental health professionals in distinguishing aspects of an LGBQ client's sociocultural context from CSBD symptomology, given recent concerns that these constructs may be wrongly conflated and result in misdiagnosis. The treatment recommendations consist of broadly applicable, evidence-based principles that can be leveraged by mental health professionals of various theoretical orientations to provide LGBQ-affirming treatment for CSBD.
Discussion and Conclusions
The present article provides theoretically and empirically supported recommendations for mental health professionals who want to provide LGBQ-affirming care for CSBD. Given the preliminary nature of these recommendations, future research is needed to investigate their clinical applicability and efficacy.
Az első hazai tapasztalatok összegzése kromoszomális microarray-analízis és teljesexom-szekvenálás módszerekkel a magzati diagnosztikában
Summary of the first Hungarian experiences with prenatal chromosomal microarray analysis and whole-exome sequencing
Introduction: One of the major technological innovations of the last decade has been the proliferation of high-throughput molecular genetic testing methods, such as chromosomal microarray analysis (CMA) and whole-exome sequencing (WES) in prenatal diagnostics. Objective: Over the past 5 years, our working group has performed more than 252 prenatal examinations, indicated by ultrasound abnormalities of varying severity. Depending on the results of classical cytogenetic studies, we performed high-resolution CMA and WES analyses, with the aim to map the proportion of excess genetic information in the Hungarian population, as described in the literature. Method: CMA studies were performed using the “GeneChip System 3000 Instrument” platform with SNP-based comparative hybridization. We also performed next-generation sequencing of the whole human exome using IonTorrent and Illumina platforms. Results: A total of 252 fetal CMA examinations were performed and 42% showed some loss or gain, of which 22% showed pathogenic abnormalities. We performed WES in 42 CMA-negative cases, of which 9 (21.4%) were identified as pathogenic abnormalities supporting the inheritance process, with presumed association with fetal phenotype, based on the ClinVar database or ACMG classification. Discussion: Given the indirect nature of fetal phenotype assessment, prenatal CMA and WES analysis should be limited primarily to genes and chromosomal regions associated with ultrasound-identifiable symptoms. Parental examination is of paramount importance in both CMA and WES analyses, especially in cases where the resulting disorder cannot be clearly associated with ultrasound abnormalities. Conclusion: It is important to define the parameters by which copy number variations are detected in fetal samples. Recommendations for reporting variants confirmed by WES testing should also be given (taking international recommendations into account). These will provide more useful information for prenatal clinical genetic counselling. Orv Hetil. 2024; 165(14): 523–530.
Dohányzó várandósok elsődleges védőnői állapotfelmérése az alapellátásban
Tobacco smoking primary survey of pregnant women in the maternity and child health service
Introduction: Smoking of pregnant women can cause a number of complications in obstetrics and neonatology. Preventing them in Hungary, there is a pre-eminent option of collaboration between general practitioners and nurses of maternity and child health service in the primary care. Service nurses can assess the smoking habits of expectant mothers and collaborate with general practitioners in targeted smoking cessation/quitting programmes. Objective: testing such a programme, we arranged a pilot study in the maternity and child health service network of Nyíregyháza (a large city in Hungary) between October 1, 2019 and March 31, 2021 targeting all registered pregnant women. Method: The paper-based questionnaires were administered by the service nurses at the first visit of the pregnant women. 9 questions concerned basic biometric, socio-demographic, family planning data and (further 9 questions) especially cigarette smoking habits, environmental smoke, maternal and neonatal harms of smoking. Statistical analysis was performed by analyzing frequencies and cross-tabulation with significance level at p<0.05. Results: Reply was received by 87.9% (n = 1548) of the entire population (n = 1761). Average age of registered women was 30.2 (min./max. 15/48), first time visit to the service was in the 10.8th week (min./max. 6/34) of their pregnancy on average. Medium and higher level of education, 46.0% and 42.8%, respectively, was considerable. The proportion of Roma origin was 4.2%. Pregnancy was planned in 88.5%. Never smokers were 46.5%, past smokers were 55.3%. Current smokers were 10.1%, but 42.5% of former smokers admitted non-smoking status. Prevalence of passive smokers due to husband/partner smoking habit (n = 1493) was 30.3%. All participants knew exactly the harmful effect of smoking on the fetus. Conclusion: The role of higher education in urban environment was a significant contribution to the knowledge of harmful effects of smoking for the fetus. We found a significant difference to the disadvantage of Roma origin pregnant women in continued smoking during the pregnancy. As for environmental harmful effect, there was a clear disadvantage of nearly one third rate of husband’s/partner’s smoking. In rural and urban environment, the maternity and child health service provides a best option to detect the most endangered female population. Based on real data, collaborating general practitioners and service nurses can arrange the most effective way of tobacco smoking cessation/quitting during pregnancy. Orv Hetil. 2024; 165(14): 545–552.
Egy büntetlenül maradt gyermekbántalmazás tanulságai
Lessons of an unpunished child abuse
Around 2000–2500, physically abused children get into the sight of child protective services in Hungary. However, the number of unrecognized cases can be a multiple of this number. Cases with physical injury or severe neglect are often first seen by healthcare providers or, rather, alone in many cases. The reporting willingness of healthcare workers is low, and they often fail to fulfill their obligation to report. Apart from the consequences of failing the reporting obligations, we want to draw attention to the preventive role of reporting. The one-and-a-half-year-old girl was taken to the local dentist by her foster mother in a state of unconsciousness, mentioning food aspiration. The child was hospitalized after her deteriorating condition required resuscitation. The child was in a state of brain death during her whole hospital treatment. Bilateral frontal and multiple chest hematomas were recorded on admission; the CT described brain edema and double skull fracture. The child died on the 6th day of treatment. The case was not reported to the authorities, not during her treatment, and not when she died. Pathological autopsy found subdural bleeding and two skull fractures with different timing. The case was reported to the authorities 9 years later. The investigation found that the child died due to a head injury caused by the underaged son of the foster parents, who could not be punished due to his age at the time of the crime. The criminal responsibility of the foster parent was excluded because of the statutory limitation. The case reveals that strengthening forensic medical knowledge would be needed, but the optimal solution would be introducing clinical forensic medicine into Hungarian clinical practice. Orv Hetil. 2024; 165(14): 553–559.
Klinikai táplálás az intenzív osztályon: az EuroPN-vizsgálat magyarországi eredményei
Artificial nutrition in intensive care: Hungarian results of the EuroPN study
Introduction: The importance of artificial nutrition in critical illness is well known; the lack of it can cause delayed wound healing and increase in ventilator days. Objective: The objective of the previously published EuroPN study was to assess the nutritional practice across Europe amongst the participating intensive care units and examine the effect of calory and protein intake in weaning from mechanical ventilation and 90-day mortality. This manuscript will analyze the Hungarian data out of the EuroPN study. Method: We included all patients with length of stay >5 days during the screening month. Clinical and nutritional data were collected retrospectively for the first 5 days and prospectively thereafter until day 15 (or discharge/death). Patient outcome data were collected on day 15, 30 and 90. Results: There were 111 patients included from 6 Hungarian intensive care units. The analysis of cumulative calory and protein intake of these patients showed that the ESPEN target was achieved at a much higher proportion in Hungary compared to the European patients: 92% of calory target was reached (95% CI 68; 118) vs. 83% in European patients (95% CI 59; 107). The protein target showed even higher difference: patients in Hungary reached the target in 83% (95% CI 57; 121), compared to 65% in European patients (95% CI 41; 91). Discussion and conclusion: The higher cumulative calory and protein intake significantly reduced the number of ventilator days in the EuroPN study. The Hungarian patients reached this target earlier, by day 3; this was achieved by using the supplementary parenteral nutrition earlier. Orv Hetil. 2024; 165(14): 531–537.
Lehetne-e csökkenteni az enyhe koponyasérültek sürgősségi koponya-CT-vizsgálatainak számát?
Could the head CT scans be reduced for patients with minor head injury in the emergency practice?
Introduction: Skull and brain injuries (craniocerebral traumas) should be classified according to internationally accepted standards, their frequency and distribution varies from country to country. The frequency of skull and brain injuries in Hungary varies about 2,000 skull injuries per 100,000 inhabitants. No more than a quarter of them involve hospitalization. The number of CT examinations performed in the United States and in our country has doubled in the past 20–30 years. Nearly 90% of the skull CT scans are negative. Patients with minimal head injuries do not experience loss of consciousness or other neurological changes and have GCS values of 13–15. Following observation, the majority of patients with these minor injuries could be discharged without any consequences. Objective: The inefficient use of CT examinations significantly increases unnecessary radiation doses and health care costs. To mitigate these, there are several well-proven regulatory systems in force abroad. However, their use has not yet become a routine in our country. Our aim was to investigate how the number of head CT scans in our emergency unit could have been reduced. Method: In this study, we examined the method of care for patients with cranial injuries presenting at the Békés County Emergency Department. Results: Results of this retrospective analysis, compared with the Canadian Cranial CT Rules, suggest that the number of urgent cranial CT examinations could have been reduced by 70%. Conclusion: Applying the standard systems that have already been efficient abroad, it would be significantly possible to improve the efficiency of care for minor head injuries in Hungarian emergency practice as well. Orv Hetil. 2024; 165(14): 538–544.
Abstract
Psilocybe zapotecorum is a strongly blue-bruising psilocybin mushroom used by indigenous groups in southeastern Mexico and beyond. While this species has a rich history of ceremonial use, research into its chemistry and genetics has been limited. Herein, we report on mushroom morphology, cultivation parameters, chemical profile, and the full genome sequence of P. zapotecorum. First, we detail growth and cloning methods that are simple, and reproducible. In combination with high resolution microscopic analysis, the strain was identified by DNA barcoding, confirming the field identification. Full genome sequencing reveals the architecture of the psilocybin gene cluster in P. zapotecorum, and can serve as a reference genome for Psilocybe clade I. Characterization of the tryptamine profile revealed a psilocybin concentration of 17.9 ± 1.7 mg/g, with a range of 10.6–25.7 mg/g (n = 7), and similar tryptamines (psilocin, baeocystin, norbaeocystin, norpsilocin, aeruginascin, and 4-HO-tryptamine) in lesser concentrations for a combined tryptamine concentration of 22.5 ± 3.2 mg/g. These results show P. zapotecorum to be a potent and chemically variable Psilocybe mushroom. Chemical profiling, genetic analysis, and cultivation assist in demystifying these mushrooms. As clinical studies with psilocybin gain traction, understanding the diversity of Psilocybe expands the conversation beyond the molecule.
Abstract
Psychological flexibility has been proposed as a core process of change when psychedelics are used for therapeutic purposes, but to date empirical outcomes have only documented changes on the Acceptance and Action Questionnaire (AAQ-II), a very general measure of psychological flexibility. This pilot study measured outcomes from psilocybin administered in a retreat setting across a range of measures assessing aspects of psychological flexibility. Nine participants attended a 7-day psilocybin retreat and completed measures at baseline, 2-, and 6-month follow up. Participants demonstrated significant improvements in cognitive defusion (Cognitive Fusion Questionnaire), valued living (Valuing Questionnaire), and Self-Compassion (Self-Compassion Scale), as well as a trend towards increased overall psychological flexibility (AAQ). Other outcome and process measures included measures related to acute effects of the psilocybin, belief in oneness, social safeness, mental health, burnout and emotion expressivity. These results offer preliminary evidence that therapeutic benefits obtained from psilocybin experiences may be linked to changes in psychological flexibility.
